The $880 Billion Question Continues: Dr Oz's Confirmation and the Future of Medicaid
Last week, I explored the $880 billion question facing Congress—whether lawmakers could achieve their budget goals without cutting Medicaid. This week, that question took center stage as Dr Mehmet Oz, President Trump's nominee to lead the Centers for Medicare and Medicaid Services (CMS), faced a Senate Finance Committee confirmation hearing that revealed much about the administration's approach to health care policy.1
Dr Oz's Confirmation Dance
In a tense hearing that lasted several hours, Dr Oz repeatedly dodged direct questions about whether he would oppose cuts to Medicaid. When pressed by multiple Democratic senators on his commitment to protect the program, Dr Oz offered a carefully worded response that has become emblematic of the administration's approach:2
"I cherish Medicaid and I've worked within the Medicaid environment quite extensively," Dr Oz stated, before adding that protecting Medicaid means "making sure that it's viable at every level."2
This pattern of evasion continued throughout the hearing, with Dr Oz avoiding direct commitments about program funding while emphasizing concepts like "viability" and "modernization."2 The approach mirrors the strategy employed by Department of Health and Human Services (HHS) Secretary Robert F Kennedy Jr in his own confirmation hearings, suggesting a coordinated effort to maintain flexibility for future budget decisions.
Senate Approves Spending Bill
While Dr Oz was navigating questions about Medicaid's future, the Senate narrowly averted a government shutdown by passing a Republican-written stopgap spending measure that funds the government through September 30. The key vote came when Senator Chuck Schumer and 9 other Democrats joined Republicans in allowing the measure to advance, effectively thwarting a potential filibuster by their own party.3
This action came just hours before a midnight deadline to avoid a lapse in funding. The spending debate inflamed intraparty tensions among Democrats about how to mount the most effective resistance to President Trump at a time when he is taking full advantage of his governing trifecta—control of the White House, Senate, and House.3
Rural Communities and Children at Risk
The implications of potential Medicaid cuts would be particularly devastating for rural communities. Rural hospitals, already operating on thin margins, could face closure if Medicaid funding is reduced. According to a Congressional Budget Office analysis, the Republican budget goals cannot be reached without reducing spending on Medicaid, which accounts for 93% of all remaining non-Medicare mandatory spending under the Energy and Commerce Committee's jurisdiction.4
The human cost of these potential cuts extends to families across America. During the hearing, senators highlighted examples of working parents with children suffering from rare diseases who rely on Medicaid to afford medical care. In rural areas, where health care options are already limited, families might need to drive hours to access care if local facilities close due to funding cuts.2
The impact on children would be equally severe. In New Hampshire alone, the Republican budget could take away health insurance from as many as 30 000 children. Nationwide, Medicaid covers approximately 40% of all births and 50% of rural births.2
The Work Requirements Question
Dr Oz did provide some insight into his views on Medicaid by expressing support for work requirements, suggesting that ObamaCare's Medicaid expansion has grown the program far beyond its original purpose. He indicated that Medicaid expansion made sense for some states but not others, and that the program's growth has exceeded what was envisioned when the Affordable Care Act (ACA) was originally passed.2
However, he suggested work requirements can be implemented without the onerous paperwork requirements that have been a hallmark of state attempts in the past, acknowledging that administrative barriers shouldn't be used to block eligible people from accessing care.2
Medicare Advantage Overpayments
In a notable shift, Dr Oz indicated he thinks private Medicare Advantage insurers are being overpaid by the government. "We're paying more for Medicare Advantage than we're paying for regular Medicare, so it's upside down," Dr Oz said.2 This position represents a departure from his previous advocacy for Medicare Advantage plans and his once-proposed "Medicare Advantage For All" plan.
His acknowledgment of potential fraud and abuse in the Medicare Advantage system suggests he may be open to reforms that could generate savings without directly cutting benefits to beneficiaries.
Looking Ahead
As the confirmation process continues, the battle over Medicaid's future is far from over. The House Energy and Commerce Committee is still tasked with identifying where it will need to cut $880 billion in spending over the next decade to hit the targets laid out in the House Republicans' budget.3
The most likely outcome is a continued strategy of obfuscation—avoiding direct cuts to Medicaid while implementing policies that effectively reduce benefits and eligibility. This could include stricter work requirements, reduced federal matching rates, or block grants that cap federal contributions regardless of need.
For the millions of Americans who depend on Medicaid—including children, pregnant women, people with disabilities, and rural communities—their health care future is uncertain. As Dr Oz potentially takes the helm at CMS, his actions will speak louder than his carefully crafted testimony. The $880 billion question remains unanswered, but the direction seems increasingly clear: Medicaid as we know it is in the crosshairs, regardless of how carefully nominees dance around the issue.
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References
1. Weixel N. Oz dodges questions about Medicaid cuts in confirmation hearing. The Hill. March 14, 2025. Accessed March 17, 2025. https://thehill.com/policy/health care/5195577-oz-dodges-questions-medicaid-cuts-confirmation-hearing/
2. Dr Oz testifies at his confirmation hearing to oversee Medicare, Medicaid agency. Face the Nation. Published March 14, 2025. Accessed March 17, 2025. https://www.youtube.com/watch?v=f4E8FriQLfg&ab_channel=FacetheNation
3. Trump Administration highlights: Senate approves spending bill to avert government shutdown. The New York Times. Updated March 17, 2025. Accessed March 17, 2025. https://www.nytimes.com/live/2025/03/14/us/trump-government-shutdown-news
4. Congressional Budget Office. Letter to representatives Boyle and Pallone regarding mandatory spending under the jurisdiction of the House Committee on Energy and Commerce. Published March 5, 2025. Accessed March 17, 2025. https://www.cbo.gov/system/files/2025-03/61235-Boyle-Pallone.pdf
